Independent, Physician-Led Primary Care: A Model for More Affordable Care
Investment in primary care can lower health costs while improving outcomes. When patients can access timely primary care, they avoid more expensive specialist copays and prevent minor issues from escalating into life-threatening or chronic conditions. Not only does this reduce costs for individuals and families, but it can have a ripple effect, reducing what all of us spend on Medicare and Medicaid, particularly in a state like New Hampshire with an older population. Derry Medical Center (DMC), the largest independent primary care group in New Hampshire, offers a compelling case study in how this approach works in practice.
Expanding Access to Primary Care
Founded in 1964, DMC has grown from a single office to now serving eight communities across the Granite State. As healthcare consolidation continues statewide, DMC's physician-owned model offers a compelling alternative that delivers quality primary care at costs below the market rate.
Dr. Doug Dreffer, a family physician, board member, and shareholder, joined DMC in 2017 after two decades at Concord Hospital. He explained that "access is a big part of the model, both for patient satisfaction but also for cost of care.” Recalling advice from a mentor during his training, he stated that “patients want three things from their provider: accessibility, affability, and ability, in that order.” This philosophy mirrors DMC’s approach to healthcare.
While most offices close by 5 p.m., DMC stays open until 8 p.m. at most locations, three days a week. They offer Saturday hours at two clinics and walk-in services at three. This extended availability means that patients access care when they need it, from providers they are more likely to know and trust, instead of defaulting to far more expensive alternatives.
“Patients don't have to miss work. They can come in at 7:30 am for their physical, get their refills processed at 8 pm, or come out on a Saturday for their diabetes check,” noted Dr. Dreffer. “And they don't have to go to urgent care or the emergency room, which is very expensive and can take hours of waiting,” he added.
Lower Costs, Better Outcomes
Beyond cost savings, the practice’s focus on continuity and preventive care is validated by measurable health outcomes. DMC reports that the admission rates for patients with congestive heart failure run at approximately 60% of the national average, emergency room utilization is significantly lower than comparable populations, and, despite serving 140,000 active patients, on-call physicians receive only about three calls per night.
"Our people with congestive heart failure don't get admitted to the hospital as much as in other systems,” said Dr. Dreffer. “It’s because we see them frequently before they get sick enough to require that level of care." At DMC, patients with chronic conditions are ideally seen every 90 days, regardless of symptoms. The investment in regular visits lets staff identify potential issues early, preventing expensive hospitalizations down the line.
The Case for Independence
Both cost savings and improved outcomes are closely tied to DMC’s independence. Compared with larger hospital systems, DMC's services run about 15% below the price curve for primary care. “Provider-to-provider, they're not necessarily better or worse than me by 15 percent," Dr. Dreffer explained. "They're just more expensive than I am by 15 percent, just like the rent in this building is probably less than it would be if it were on the hospital campus.”
Large hospital systems carry facility fees and regulatory requirements that get passed on to patients and insurers. DMC, as an independent practice, avoids many of these overhead costs while maintaining the same quality of care. This financial flexibility allows the group to reinvest in patient-centered services instead of administrative layers – the factors that actually improve outcomes – and keep costs down across the board.
Additionally, the physician-owned model creates increased transparency, trust, and personal connection. The doctors making decisions about practice hours, locations, and services are the same ones who provide care, ensuring that clinical priorities drive operational choices. "People tend to like their doctor," shared Dr. Dreffer, "and they'd like to know that he or she is the one making the decisions about the practice."
Hub Model: Comprehensive Care Under One Roof
The savings extend beyond primary care visits. DMC's facilities increasingly function as healthcare hubs, co-located with independent specialty practices and imaging centers that share DMC's commitment to cost-effective care. In this model, for example, freestanding radiology services can be up to 70% less expensive than hospital-based imaging.
This pricing structure matters greatly for patients with high-deductible plans, who pay out-of-pocket until they meet their deductibles. Lower costs mean patients can access care without the financial barrier that can lead them to delay treatment until conditions worsen. For uninsured patients, who represent around 5% of the patient base, DMC offers flat-fee self-pay rates with flexible payment plans to help patients manage outstanding balances.
DMC’s hub model also streamlines care delivery behind the scenes. Providers focus on patients, while support staff handle prior authorizations, scheduling, refills, and documentation. "We're a human labor-heavy system," Dr. Dreffer noted. “I feel like I can give better care and continue to provide access because I have colleagues focused on these taks behind the scenes.”
Those investments translate into both provider satisfaction and a simpler, more efficient experience for patients. In a healthcare system that is increasingly complex and fractured, getting a range of services at a single site can reduce the mental and administrative load.
A Model Worth Replicating
DMC's experience validates the New Hampshire Health Cost Initiative's (NHHCI) call for primary care investment while demonstrating what that investment looks like in action: accessible appointments, complementary services, preventive care, lower facility costs, and provider-led decision making. This raises a critical question for our health care system: how to expand or incentivize this model of care in other settings?
"The propagation of independent primary care would be better for the state economically," Dr. Dreffer argued, "for all the reasons that it's worked for us." Today, only a handful of independent primary care physicians remain outside hospital systems. At the same time, the hospital consolidation trend has moved costs upward while narrowing patient choice.
As New Hampshire grapples with rising costs and an aging population, policymakers and healthcare leaders can create the conditions for DMC’s primary care model to spread. This type of investment can deliver lower costs and better access and help build a healthcare system in the Granite State that's both affordable and effective, rather than one where access to quality care becomes an increasingly expensive luxury.
About Doug Dreffer, MD
Dr. Dreffer received a Bachelor of Arts degree from Williams College in Williamstown, MA, and his Doctor of Medicine degree from The Ohio State University College of Medicine in Columbus, Ohio. He has been a Family Practice provider since 1997 and was the medical director and then program director for the NH Dartmouth Family Medicine Residency Program at Concord Hospital. Dr. Dreffer is accepting new patients in DMC’s Concord office.
